Diffuse Lung Disease |

Chronic Pulmonary Aspergillosis in Patients With Sarcoidosis FREE TO VIEW

Beatriz Abascal-Bolado; James Utz; Sanjay Kalra; Eva Carmona Porquera, PhD
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Mayo Clinic, Rochester, MN

Chest. 2014;146(4_MeetingAbstracts):364A. doi:10.1378/chest.1994015
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SESSION TITLE: Interstitial Lung Disease Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Patients with sarcoidosis are at risk to develop pulmonary fibrosis and cystic lesions. Some of these patients can complicate with chronic fungal infections in the form of Chronic Pulmonary Aspergillosis (CPA). The aim of this study is to describe the frequency, clinical presentation, radiological findings, risk factors and treatment of these patients.

METHODS: We reviewed the medical records of all patients with sarcoidosis (compatible clinical history and biopsy-proven non-necrotizing granulomas) who had been diagnosed with CPA at our institution over the last 30 years.

RESULTS: 29 patients were identified. The median age of sarcoidosis diagnosis was 38±11 yrs and 20 (69%) patients were male. Of the patients with listed ethnic group 14 (48%) were Caucasians, 10 (40%) African-American and 1 (3%) was Asian. The mean of years between the diagnosis of sarcoidosis and the development of CPA was 11±10 years. The most common symptoms were hemoptysis in 25 (86%) patients, cough in 24 (83%), substantial sputum in 15 (52%) and fever in 14 (48%). 18 (62%) patients had stage IV sarcoidosis at the time of the diagnosis. Cavitary lesions were present in 26 (90%) patients, 17 (59%) of which presented with a unique cavity; with the majority locating to the upper lobes. Fungus ball were reported in 23 (79%) of the patients. Restrictive pattern was found in 9 (31%) patients, obstruction in 8 (28%) and mixed in 7 (24%). A. fumigatus was the most common isolate found in 19 (66%) patients followed by A. flavus in 5 (17%). More than 90% of the patients received glucocorticoids prior to the development of the CPA. Of the patients that received treatment for the CPA, 20 (69%) patients received antifungal therapy, 11 (38%) surgery, 6 (21%) embolization, 1 (3%) was treated with steroids and 1 (3%) with antibiotic. 10 (34%) patients received different combinations of the prior treatments.

CONCLUSIONS: CPA complicating sarcoidosis is uncommon in our cohort and usually occurs in patients with active and severe sarcoidosis that had received prior steroid treatment. Surgery and antifungal therapy were the most frequent treatments in our cohort.

CLINICAL IMPLICATIONS: CPA is a rare complication of patients with advance sarcoidosis. Management is complicated and frequently requires the combination of antifungal therapy with either embolization or surgery or both.

DISCLOSURE: The following authors have nothing to disclose: Beatriz Abascal-Bolado, James Utz, Sanjay Kalra, Eva Carmona Porquera

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